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Journal of Anesthesia
Published in: Journal of Anesthesia 4/2021

01-08-2021 | Pain Syndromes | Original Article

Predictors of one year chronic post-surgical pain trajectories following thoracic surgery

Authors: Christopher W. Liu, M. Gabrielle Page, Aliza Weinrib, Dorothy Wong, Alexander Huang, Karen McRae, Joseph Fiorellino, Diana Tamir, Michael Kahn, Rita Katznelson, Karim Ladha, Faraj Abdallah, Marcelo Cypel, Kazuhiro Yasufuku, Vincent Chan, Monica Parry, James Khan, Joel Katz, Hance Clarke

Published in: Journal of Anesthesia | Issue 4/2021

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Abstract

Purpose

Chronic post-surgical pain (CPSP) is a highly prevalent complication following thoracic surgery. This is a prospective cohort study that aims to describe the pain trajectories of patients undergoing thoracic surgery beginning preoperatively and up to 1 year after surgery

Methods

Two hundred and seventy nine patients undergoing elective thoracic surgery were enrolled. Participants filled out a preoperative questionnaire containing questions about their sociodemographic information, comorbidities as well as several psychological and pain-related statuses. They were then followed-up during their immediate postoperative period and at the three, six and 12 month time-points to track their postoperative pain, complications and pain-related outcomes. Growth mixture modeling was used to construct pain trajectories.

Results

The first trajectory is characterized by 185 patients (78.1%) with mild pain intensity across the 12 month period. The second is characterized by 32 patients (7.5%) with moderate pain intensity immediately after surgery which decreases markedly by 3 months and remains low at the 12 month follow-up. The final trajectory is characterized by 20 patients (8.4%) with moderate pain intensity immediately after surgery which persists at 12 months. Patients with moderate to severe postoperative pain intensity were much more likely to develop CPSP compared to patients with mild pain intensity. Initial pain intensity levels immediately following surgery as well as levels of pain catastrophizing at baseline were predicting pain trajectory membership. None of the surgical or anesthetic-related variables were significantly associated with pain trajectory membership.

Conclusion

Patients who undergo thoracic surgery can have postoperative pain that follows one of the three different types of trajectories. Higher levels of immediate postoperative pain and preoperative pain catastrophizing were associated with moderately severe CPSP.
Literature
1.
Yoon S, Hong WP, Joo H, Kim H, Park S, Bahk JH, et al. Long-term incidence of chronic postsurgical pain after thoracic surgery for lung cancer: a 10 year single-center retrospective study. Reg Anesth Pain Med. 2020;45(5):331–6.PubMedCrossRef
2.
Steegers MA, Snik DM, Verhagen AF, van der Drift MA, Wilder-Smith OH. Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain. 2008;9(10):955–61.PubMedCrossRef
3.
Li WW, Lee TW, Lam SS, Ng CS, Sihoe AD, Wan IY, et al. Quality of life following lung cancer resection: video-assisted thoracic surgery vs thoracotomy. Chest. 2002;122(2):584–9.PubMedCrossRef
4.
Furrer M, Rechsteiner R, Eigenmann V, Signer C, Althaus U, Ris HB. Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg. 1997;12(1):82–7.PubMedCrossRef
5.
Bendixen M, Jorgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17(6):836–44.PubMedCrossRef
6.
Rizk NP, Ghanie A, Hsu M, Bains MS, Downey RJ, Sarkaria IS, et al. A prospective trial comparing pain and quality of life measures after anatomic lung resection using thoracoscopy or thoracotomy. Ann Thorac Surg. 2014;98(4):1160–6.PubMedPubMedCentralCrossRef
7.
Bayman EO, Lennertz R, Brennan TJ. Pain-related limitations in daily activities following thoracic surgery in a United States population. Pain Physician. 2017;20(3):E367–78.PubMedCrossRef
8.
Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ. A prospective study of chronic pain after thoracic surgery. Anesthesiology. 2017;126(5):938–51.PubMedCrossRef
9.
Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12(1):50–5.PubMedCrossRef
10.
Yarnitsky D, Crispel Y, Eisenberg E, Granovsky Y, Ben-Nun A, Sprecher E, et al. Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk. Pain. 2008;138(1):22–8.PubMedCrossRef
11.
Behera BK, Puri GD, Ghai B. Patient-controlled epidural analgesia with fentanyl and bupivacaine provides better analgesia than intravenous morphine patient-controlled analgesia for early thoracotomy pain. J Postgrad Med. 2008;54(2):86–90.PubMedCrossRef
12.
Mukherjee M, Goswami A, Gupta SD, Sarbapalli D, Pal R, Kar S. Analgesia in post-thoracotomy patients: comparison between thoracic epidural and thoracic paravertebral blocks. Anesth Essays Res. 2010;4(2):75–80.PubMedPubMedCentralCrossRef
13.
Khan RS, Skapinakis P, Ahmed K, Stefanou DC, Ashrafian H, Darzi A, et al. The association between preoperative pain catastrophizing and postoperative pain intensity in cardiac surgery patients. Pain Med. 2012;13(6):820–7.PubMedCrossRef
14.
Wildgaard K, Ringsted TK, Hansen HJ, Petersen RH, Kehlet H. Persistent postsurgical pain after video-assisted thoracic surgery–an observational study. Acta Anaesthesiol Scand. 2016;60(5):650–8.PubMedCrossRef
15.
Katz J, Asmundson G, McRae K, Halket E. Emotional numbing and pain intensity predict the development of pain disability up to one year after lateral thoracotomy. Eur J Pain. 2008;13:870–8.PubMedCrossRef
16.
Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg. 2009;36(1):170–80.PubMedCrossRef
17.
Amaya F. A good beginning makes a good ending: association between acute pain trajectory and chronic postsurgical pain. J Anesth. 2018;32(6):789–91.PubMedCrossRef
18.
Chapman CR, Donaldson GW, Davis JJ, Bradshaw DH. Improving individual measurement of postoperative pain: the pain trajectory. J Pain. 2011;12(2):257–62.PubMedPubMedCentralCrossRef
19.
Page MG, Katz J, Curtis K, Lutzky-Cohen N, Escobar EM, Clarke HA. Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty. J Anesth. 2016;30(4):568–77.PubMedCrossRef
20.
Page MG, Katz J, Romero Escobar EM, Lutzky-Cohen N, Curtis K, Fuss S, et al. Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty. Pain. 2015;156(3):460–8.PubMedCrossRef
21.
Chapman CR, Davis J, Donaldson GW, Naylor J, Winchester D. Postoperative pain trajectories in chronic pain patients undergoing surgery: the effects of chronic opioid pharmacotherapy on acute pain. J Pain. 2011;12(12):1240–6.PubMedCrossRef
22.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (strobe) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9.CrossRef
23.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. an updated literature review. J Psychosom Res. 2002;52(2):69–77.PubMedCrossRef
24.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.CrossRefPubMed
25.
Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the anxiety sensitivity index-3. Psychol Assess. 2007;19(2):176–88.PubMedCrossRef
26.
McCracken LM, Dhingra L. A short version of the pain anxiety symptoms scale (PASS-20): preliminary development and validity. Pain Res Manag. 2002;7(1):45–50.PubMedCrossRef
27.
Sullivan M, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32.CrossRef
28.
Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills. 1984;59(3):974.PubMedCrossRef
29.
Derogatis L. SCL-90-R Administration, scoring and procedures manual-II. Clinical psychometric research. Towson; 1983. p. 14–5.
30.
Woo A, Lechner B, Fu T, Wong CS, Chiu N, Lam H, et al. Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: a literature review. Ann Palliat Med. 2015;4(4):176–83.PubMed
31.
32.
McCracken LM, Zayfert C, Gross RT. The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain. 1992;50(1):67–73.PubMedCrossRef
33.
Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause SJ. The pain disability index: psychometric and validity data. Arch Phys Med Rehabil. 1987;68(7):438–41.PubMed
34.
Asparouhov T, Muthen B. Multilevel mixture models. In: Hancock GR, Samuelsen KM, editors. Advances in latent variable mixture models. Charlotte, NC: Information Age Publishing Inc; 2008. p. 27–51.
35.
Muthen B, Asparouhov T. Growth mixture modeling Analysis with non-Gaussian random effects. In: Fitzmaurice G, Davidian M, Verbeke G, Molenberghs G, editors. Longitudinal Data Analysis. Boca Raton: CRC Print ; 2009. p. 143–65.
36.
Muthen B, Shedden K. Finite mixture modeling with mixture outcomes using the EM algorithm. Biometrics. 1999;55:463–9.PubMedCrossRef
37.
38.
39.
Akaike A. Information measures and model selection. Int Stat Instit. 1983;44:277–91.
40.
deLeeuw J. Introduction to Akaike (1973) information theory and an extension of the maximum likelihood principle. In: Kotz S, Johnson NL, editors. Breakthrough in statistics. 1st ed. London: Springer; 1992. p. 599–609.CrossRef
41.
Katz J, Asmundson GJ, McRae K, Halket E. Emotional numbing and pain intensity predict the development of pain disability up to one year after lateral thoracotomy. Eur J Pain. 2009;13(8):870–8.PubMedCrossRef
42.
Turner JA, Anderson ML, Balderson BH, Cook AJ, Sherman KJ, Cherkin DC. Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain. 2016;157(11):2434–44.PubMedPubMedCentralCrossRef
43.
Gibson E, Sabo MT. Can pain catastrophizing be changed in surgical patients? Sc Rev Can J Surg. 2018;61(5):311–8.CrossRef
44.
Nelson EA, Dowsey MM, Knowles SR, Castle DJ, Salzberg MR, Monshat K, et al. Systematic review of the efficacy of pre-surgical mind-body based therapies on post-operative outcome measures. Complement Ther Med. 2013;21(6):697–711.PubMedCrossRef
45.
Darnall BD. Pain psychology and pain catastrophizing in the perioperative setting: a review of impacts, interventions, and unmet needs. Hand Clin. 2016;32(1):33–9.PubMedPubMedCentralCrossRef
46.
Abid Azam M, Weinrib AZ, Montbriand J, Burns LC, McMillan K, Clarke H, et al. Acceptance and commitment therapy to manage pain and opioid use after major surgery: preliminary outcomes from the toronto general hospital transitional pain service. Can J Pain. 2017;1(1):37–49.CrossRefPubMedPubMedCentral
47.
Krebs ED, Mehaffey JH, Sarosiek BM, Blank RS, Lau CL, Martin LW. Is less really more? Reexamining video-assisted thoracoscopic versus open lobectomy in the setting of an enhanced recovery protocol. J Thorac Cardiovasc Surg. 2019;159(1):284–94.CrossRef
48.
49.
Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. Rev Predict Factors Anesthesiol. 2000;93(4):1123–33.
50.
Katz J. One man’s risk factor is another man’s outcome: difference in risk factor profiles for chronic postsurgical pain maintenance vs transition. Pain. 2012;153(3):505–6.PubMedCrossRef
51.
Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother. 2009;9(5):723–44.PubMedCrossRef
52.
McNicol ED, Schumann R, Haroutounian S. A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain. Acta Anaesthesiol Scand. 2014;58(10):1199–213.PubMedCrossRef
53.
Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013;111(5):711–20.PubMedPubMedCentralCrossRef
54.
von Knorring L, Perris C, Eisemann M, Eriksson U, Perris H. Pain as a symptom in depressive disorders. II. Relationship to personality traits as assessed by means of KSP. Pain. 1983;17(4):377–84.CrossRef
55.
Lee P, Zhang M, Hong JP, Chua HC, Chen KP, Tang SW, et al. Frequency of painful physical symptoms with major depressive disorder in asia: relationship with disease severity and quality of life. J Clin Psychiatr. 2009;70(1):83–91.CrossRef
56.
Aguera-Ortiz L, Failde I, Mico JA, Cervilla J, Lopez-Ibor JJ. Pain as a symptom of depression: prevalence and clinical correlates in patients attending psychiatric clinics. J Affect Disord. 2011;130(1–2):106–12.PubMedCrossRef
57.
Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–45.PubMedCrossRef
58.
Williams LS, Jones WJ, Shen J, Robinson RL, Weinberger M, Kroenke K. Prevalence and impact of depression and pain in neurology outpatients. J Neurol Neurosurg Psychiatry. 2003;74(11):1587–9.PubMedPubMedCentralCrossRef
59.
60.
Bayman EO, Brennan TJ. Incidence and severity of chronic pain at 3 and 6 months after thoracotomy: meta-analysis. J Pain. 2014;15(9):887–97.PubMedCrossRef
Metadata
Title
Predictors of one year chronic post-surgical pain trajectories following thoracic surgery
Authors
Christopher W. Liu
M. Gabrielle Page
Aliza Weinrib
Dorothy Wong
Alexander Huang
Karen McRae
Joseph Fiorellino
Diana Tamir
Michael Kahn
Rita Katznelson
Karim Ladha
Faraj Abdallah
Marcelo Cypel
Kazuhiro Yasufuku
Vincent Chan
Monica Parry
James Khan
Joel Katz
Hance Clarke
Publication date
01-08-2021
Publisher
Springer Singapore
Published in
Journal of Anesthesia / Issue 4/2021
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-021-02943-7

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